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        <p>罗慕是芬兰的一个儿童早期咬合诱导产品，类似于MRC，以前听过，从来没接触过。昨天医院跟罗慕公司合作办了个培训班，内部人员免费。听了一天。笔记如下。<br>先看看实物，是这样。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0163-lmpx/01.png"><br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0163-lmpx/02.png"><br>首先是青苗的孙志学老师讲罗慕早期矫治技术及临床应用。<br>早期矫治技术的原理是充分利用骨骼生长发育的机会，影响骨骼生长发育而不仅仅是排牙。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0163-lmpx/03.png"><br>罗慕矫治器的原理<br>唇颊侧诱导屏去除唇颊侧压力。<br>舌侧诱导屏，促进颌骨颊向发育。(利用发育的力量)<br>齿位引导槽:自然排齐。<br>特殊硅胶材料:高强度回弹力及剪切力。<br>后牙牙合垫区变薄，前牙变厚，阻止前牙萌出，促进前牙萌出，垂直向改变。(深覆合)<br>后牙加厚，前牙变薄。控制后牙萌出高度，加强咬肌训练。加速前牙萌出。(开合，高角患者)<br>排牙槽对上牙有水平向力，诱导前牙向前向唇侧生长。对下颌有向后的力。(反颌)<br>唇屏对上颌向内推，舌屏对下颌向外推，改善上下颌骨咬合关系，排齐牙齿。促使下切牙和下颌骨朝前生长。是逐渐进行的，没有tmj问题。<br>在牙萌出时引导牙齿靠拢，不是直接施力让牙槽骨吸收，复发率小。<br>上颌没有诱导屏，扩弓小于上颌。<br>其局限是只在生长发育期才有用。5-12岁是颌骨生长发育最快的时期，到12岁约完成颌骨发育的90%，12岁以后做正畸，拔牙概率高。生长主要发生在夜间，利用生长激素的夜间分泌，只在夜间佩戴，替牙期萌出只发生在20:00-01:00。<br>适应症<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0163-lmpx/04.png"><br>看了一下，深覆颌深覆盖，前牙拥挤，前牙个别反颌，开合，露龈笑等都可以考虑。<br>禁忌症<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0163-lmpx/05.png"><br>需要结合其它方法联合治疗的<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0163-lmpx/06.png"><br>接下来是一些病例，孙老师也说了，不是每个病例都成功的。儿童早期咬合诱导在5-10年后会成为刚需，适应症的选择对医生要求很高。罗慕的技术亮点是引导自然生长，只在晚上戴。<br>下午是北大口腔的葛立宏老师讲的。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0163-lmpx/07.png"><br>双胞胎，都做了早期矫治，是否认真戴的区别。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0163-lmpx/08.png"><br>早期做，面型发育好，稳定性好。<br>早期不做，可能要减数正畸。<br>牙合发育是长期过程，怀孕6w-18岁或更久。<br>不要任其发展。<br>利用生长潜力引导牙-牙槽骨正常发育的机会。<br>防止对牙及牙周结构的损伤，可能引起关节，牙及颌骨损伤。<br>利用生长期优势进行干预(5-12岁)。<br>预防性矫治:发生前<br>阻断性矫治:发生初期。<br>治疗性矫治:在错颌畸形完全形成后。<br>三者都是早期矫治。<br>早期矫治的主要目标是：<br>①促进牙及颌骨正常发育。<br>②消除或控制不良环境因素对正常牙合的影响。<br>③为正常牙合建立营造一个良好环境。<br>(等待，观察不能错过治疗时机)<br>④纠正和引导正牙合发育。<br>⑤消除或减少二期治疗的可能。<br>⑥最大化应用生长潜力。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0163-lmpx/09.png"><br>遗传和环境因素。<br>喂养方式:奶瓶喂养错颌畸形多。反颌，深覆盖。安慰奶嘴，开颌。<br>呼吸方式:口呼吸，鼻炎，腺样体肥大。上牙弓狭窄，上前牙前突等。脊柱侧弯。<br>饮食方式:食物变软。<br>口腔习惯:吮指，咬唇，吐舌。<br>形态及功能:肌肉位置，功能。系带。头的位置。系带切除适应症要把握。<br>早期矫治的时机<br>没有一个绝对的最好的时间。<br>正畸筛查应在4-5岁开始。<br>早期矫治可在6，1萌出后。<br>有些需要在乳牙期和混合牙列干预，反颌，锁牙合。<br>不能迟于7岁。<br>早期矫治内容和方法<br>出生:去除各种影响因素<br>儿牙医生要检查牙齿，牙列，面部发育。<br>注意五官发育<br>肌功能治疗+牙齿排齐(不能夸大肌功能治疗)<br>儿牙与正畸配合。<br>预防:发现和去除可能影响口牙合及颅面部等正常发育的不利因素。<br>引导:颌骨正常萌出，颌骨朝正常方向生长。<br>阻断:去除已经出现的早期畸形和不良习惯，阻断畸形进一步发展。<br>间隙管理<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0163-lmpx/10.png"><br>引导恒牙正常萌出。<br>咬合干扰要尽早去除。<br>反颌扩弓失败的，要考虑咬合干扰，尤其单侧反颌。<br>阻断:扩弓，牵引，重获间隙。<br>早期矫治的主要考虑因素<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0163-lmpx/11.png"><br>葛老师讲的不只是罗慕了，比较全了。<br>接下来是昆明亲亲齿科的张志宇老师讲自己使用罗慕的经验，他们是昆明最早使用罗慕的机构。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0163-lmpx/12.png"><br>适应症：不良口腔习惯，需要进行间隙管理、萌出异常、深覆盖、前牙后牙反颌、二类、三类错颌畸形。<br>介入7步曲<br>第一阶段 乳牙萌出(6-30个月)<br>口腔宣教为主，建议乳牙定期涂氟。<br>第二阶段 乳牙列发育完成(3-6岁)<br>口腔习惯:口呼吸、吮指、夜磨牙、喂养习惯，饮食习惯。<br>间隙管理:间隙保持(乳牙早失)，重获间隙(乳4早失，乳5前移)，创造间隙(扩弓)。<br>前后牙反颌干预<br>二类错颌畸形(严重下颌骨发育不足)<br>三类(必须矫治)<br>第三阶段:第一恒磨牙萌出(4-8岁)<br>与上一个阶段同，6萌出使得间隙管理更容易。<br>第四阶段:恒切牙萌出(6-8岁)<br>罗慕介入最佳时期<br>尽快建立正常切牙咬合关系，刺激颌骨发育，扩大牙弓。<br>间隙管理。<br>前后牙反颌管理。<br>二类错颌(深覆盖5MM以上必须矫治)<br>三类错颌(必须矫治)<br>第五阶段:下颌尖牙和上下4萌出(9-10岁)<br>纠正不良习惯<br>间隙管理(确保下颌3早于4萌出)<br>前牙后牙反颌的干预<br>安氏二类错颌畸形(利用生长发育高峰进行深覆合覆盖矫治)<br>三类错颌(必须矫治)<br>戴罗慕咬穿了，原因是深覆合前牙区咬合紧，应适当加厚后牙牙合垫。<br>第六阶段:7萌出(11岁)<br>不良习惯<br>间隙管理(保持第二乳磨牙的间隙)<br>前牙后牙反颌的干预(必须矫治)<br>安氏二类错颌畸形(必须矫治)<br>三类错颌(必须矫治)<br>第七阶段:上3及上下7萌出(12岁)<br>7阻生率增加，密切观察直至7建立咬合。<br>为3正常萌出，可能需要间隙展开。<br>收费：28800，话术，90%以上不用做后期矫正。<br>覆合覆盖测量:用牙周探针比着拍。<br>要留证据，每次复诊拍照。<br>发现有问题，停止。一般会恢复。<br>每个病例专人负责打卡。<br>七个步骤讲得很好，哪个阶段能干什么，不会两眼一抹黑了。<br>最后是厂家工作人员介绍对接流程。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0163-lmpx/13.png"><br>流程<br>①收集模型，照片，影像资料，上传，顺丰到付寄模型(侧位片要拍到N点)，模型藻酸盐及硅橡胶均可。口扫也行。<br>②出方案。<br>③确认制作矫治器。<br>④20d左右收到矫治器。<br>⑤使用，每半年取模制作下一个矫治器。还是要拍照。第三付再拍x片。<br>复诊周期：开始一个月，后期两到三个月，复诊的椅旁时间很短。<br>指导价：28800。<br>罗慕不是个性化的矫治器，但有400多个型号来匹配。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0163-lmpx/14.png"><br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0163-lmpx/15.png"><br>听完课的总结：咬合诱导是利用5-12岁的快速生长发育期诱导颌面部和牙弓向我们期望的方向上去发育，预防出现错颌畸形，减小需要后期矫正，尤其是减数拔牙矫正的需要。适应症的选择非常关键，最主要的适应症是深覆颌深覆盖，前牙牙列拥挤，反颌等。治疗流程是收集治疗并上传，寄出模型或上传口扫治疗，罗慕出方案，确认后制作矫治器，教患者初戴，每天夜间佩戴，三个月复诊监控，半年换一副矫治器，一般用4副。难点还是适应症的选择，不过罗慕后台有正畸团队支持会好一点。对我而言，临床上也看儿牙患者，也会常规检查其咬合情况，但是发现有问题的都是转给正畸医生。要自己上手，先把正畸的东西捡起来吧。不一定要自己干正畸，但基本知识要有。</p>
<p>我发文章的三个地方，欢迎大家在朋友圈等地方分享，欢迎点“在看”。<br>我的个人博客地址：<a href="https://zwdnet.github.io/">https://zwdnet.github.io</a><br>我的CSDN博客地址：<a target="_blank" rel="noopener" href="https://blog.csdn.net/zwdnet">https://blog.csdn.net/zwdnet</a><br>我的微信个人订阅号：赵瑜敏的口腔医学学习园地</p>
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